ABSTRACT
The
purpose of the study was to ascertain the factors influencing the utilization
of prevention of mother to child transmission (PMTCT) service among pregnant
women attending ante-natal clinic in Irrua Specialist Teaching Hospital (ISTH).The
study was a descriptive research where the researcher selected 85 pregnant
women attending antenatal clinic in ISTH, Edo State through the random sampling
technique. Data were collected by administering questionnaire. The data
collected through the questionnaire were presented using frequency tables and
percentages. The findings of the study revealed that:- Majority of the
respondents have good knowledge about prevention of mother-to-child
transmission (PMTCT) services, There is a better understanding of the practice
of PMCT among educated women than uneducated ones, Women with HIV/AIDS use
prevention of mother to child transmission irrespective of their educational
background. Based on the findings of the study, the researcher recommends that:
There is need for the involvement of the stakeholders in bridging the gap
between knowledge and utilization of PMTCT services among women. A revised
health education programme for pregnant women living with HIV should be
implemented to enlighten women on the need to utilize PMTCT services. Health
personnel should always encourage women living with HIV to utilize PMTCT
services to prevent mother-to-child transmission of the virus. Health personnel
should avoid discrimination of women living with HIV/AIDS.
TABLE
OF CONTENT
CHAPTER
ONE: INTRODUCTION
Background to the
Study- - - - - - 1
Statement of problem- - - - - - - 4
Purpose of the Study- - - - - - - 4
Research Questions- - - - - - - 5
Scope of the Study- - - - - - - 5
Limitation of the Study
- - - - - 6
Significance of the
Study - - - - - 6
Definition of Terms- - - - - - - 7
CHAPTER
TWO: REVIEW OF RELATED LITERATURE
Concept of HIV/AIDS- - - - - - 8
Theories of HIV/AIDS- - - - - - 19
Knowledge about prevention of mother to
child transmission among pregnant women- - - - - - - - 22
Factors influencing utilization of prevention
of mother-to-child transmission - - - - - - - - - 24
Prevention of mother-to-child
transmission of Human Immuno-Deficiency Virus (HIV) - - - - - - - - 35
Summary of Literature Review- - - - - 36
CHAPTER
THREE: METHODOLOGY
Research Design of the
study - - - - - 38
Population of the
study- - - - - - 38
Sample and Sampling
Technique- - - - - 39
Research Instrument- - - - - - - 39
Validity - - - - - - - - 40
Reliability Method of
Data Collection - - - - 40
Method of Data analysis
- - - - - - 41
CHAPTER
FOUR: DATA ANALYSIS AND DISCUSSION OF FINDINGS
Discussion of Findings
- - - - - 42
CHAPTER
FIVE: SUMMARY, CONCLUSION AND
RECOMMENDATIONS
Summary - - - - - - - 54
Conclusion- - - - - - - - 54
Recommendations - - - - - - - 54
REFERENCES- - - - - - - 55
Appendix- - - - - - - - 58
CHAPTER
ONE
INTRODUCTION
Background to the Study
The
greatest challenge to human kind in the 21st Century is the epidemic
of Acquired Immune Deficiency Syndrome (AIDS). Human Immune Deficiency Virus
(HIV) is the causative organism of AIDS which was first discovered in 1981.
Despite years of campaigns, advocacy, control programmes and awareness
exercises taken to curb HIV/AIDS spread, there is still a worrisome rate of
increase of the infection. According to UNAID (2006), about 33.3million people
are estimated to live with Human Immune Deficiency Virus globally; 22.5million
of this population are from the Sub-Saharan Africa.
Over
55% of these people living with HIV are women of reproductive age (15-49years)
who become pregnant. HIV infection in women of reproductive age increase the
epidemic of pre-natal HIV (UNAID 2006). About 2.5million children live with HIV
globally and 1.8million are from Sub-Saharan Africa. Worldwide, over 1700
children become infected with HIV daily (UNAID 2006).
In
Nigeria, about 69,400 children became infected with HIV through mother-to-child
transmission in 2011. This has led to a rise in the total number of children
living with HIV in the country to an unprecedented 440,000 (UNAIDS, 2012).
Majumali,
(2011), opined that, virtually all HIV infection in children occurs following
mother-to-child transmission during the ante-natal period (pregnancy),
intranatal period (labour/delivery) and the post-natal period. Mother to child
transmission of HIV is about 5-10% during pregnancy, 10-20% during labour and
10-15 during breast feeding. There is an estimation of about 20-45% chances of
a baby born to an HIV positive mother to become infected without effective
interventions to prevention of mother to child transmission. Family planning is
one of the most important Prevention of Mother to Child Transmission (PMTCT)
measures. When women living with HIV are supported to plan when they do and do
not have children, the number of children being born with HIV reduces. HIV
positive mothers are also at greater risk of dying from pregnancy – related
complication than mothers who are not living with HIV. In 2015, World Health
Organization (WHO) estimated that 4,700 maternal deaths were caused indirectly
by AIDS – related illness globally.
Studies
have shown that women living with HIV have higher unmet need for family
planning and reproductive health services than the general population. In fact
due to lack of investment in integrated family planning and HIV services, in
2014, a global survey on the sexual and productive health and rights (SRHR) of
women living with HIV, the largest to date, led by and conducted among women
living with HIV, found 60% of respondents had at least one unplanned pregnancy,
and that less than half had ever obtained family planning service. Integrating
family planning services into HIV/AIDS services has been one approach to making
both more accessible to mothers and couples living with HIV/AIDS, and
significant progress has been made in the past decade. In 2017, a systematic
review of the evidence found overall integration of family planning into HIV/AIDS
care and treatment programs with modern methods including contraceptives use
and knowledge among mothers living with HIV/AIDS.
Nigeria
is a densely populated country with high HIV prevalence, the lack of progress
here is of particular concern for Western and Central Africa. Nigeria is one of
the four countries in the world where annual infections among children are
above 10,000, the others being Mozambique, South Africa and Tanzania. Therefore,
the need to support more women to adhere to Anti-retroviral treatment during
breast feeding is a growing priority of prevention of mother to child
transmission programmes. This is because it is common for women to gradually
stop taking Anti-retroviral drugs after giving birth, which not only
compromises their health but also puts their infant at an increased risk of
acquiring HIV during breast feeding. With this effective intervention such as
use of antiretroviral drugs both for mother formula feeding the risk of mother
to child transmission has been shown to reduce by 5%. Primary preventive
measures (prevention of new infections in parents, avoiding new pregnancies in
HIV infected women) and Secondary preventive measures (preventing transmission
of HIV from an infected mother to her infants). These are the three approaches
in reducing Mother-To-Child Transmission (MTCT) promoted by the World Health
Organization (WHO) (Melntyres& Gray, 2004). Approach in Preventing
Mother-to Child Transmission MTCT to <2% includes use of combined
anti-retroviral prophylaxis, elective caesarean section and by avoiding
prolonged breastfeeding or mixed feeding, Early infant diagnosis at four to six
weeks after birth, testing of 18 months and for when breastfeeding ends and
commencement of Anti-Retroviral Treatment (ART) as soon as possible for
HIV-exposed infants. In Nigeria, despite these preventive measures of Mother To
Child Transmission, research has shown that there is low level of utilization
of these services, thus the need for this study.
Statement
of Problems
Mother
to Child Transmission (MTCT) of HIV has a lot of impact on the health of the
mother and infant including the economy of the county. MTCT increases the
prevalence of HIV in infants thereby resulting in increased infants and
maternal morbidity and mortality.
Despite the
introduction of improved preventive services of MTCT of HIV over the years, HIV
infections via MTCT (vertically/perinatal transmission) is still on the
increase in Nigeria. In 2011, about 440,000 infants were infected with HIV
(UNAID, 2012).
During the researcher’s
clinical experience in the ante natal clinic atIrrua Specialist Teaching
Hospital (ISTH) it was observed that despite availability of this prevention of
MTCT services, very few women utilized the services. For this reason this
pertinent question formed the birth rock of this study: what then are the
factors that influence the utilization of prevention of mother to child
transmission services?
Purpose
of the Study
The purpose of the study
is to ascertain the factors influencing the utilization and prevention of
mother to child transmission of HIV/AIDS among pregnant women attending ante
natal in Irrua Specialist Teaching Hospital (ISTH). Specifically, the study
aims at:
1. Determining
the level of awareness on prevention of mother to child transmission of HIV/AIDS
disease among pregnant women.
2.
Determining the socio-economic factors
influencing utilization and prevention of mother to child transmission of HIV/AIDS
disease among pregnant women in Irrua Specialist Teaching Hospital (ISTH).
3.
Ascertaining the cultural/religious
factors influencing utilization of prevention of mother to child transmission
of HIV/AIDS disease among pregnant women in Irrua Specialist Teaching Hospital
(ISTH).
Research
Questions
The following
research questions were raised to guide the study:
1.
What is the level of awareness on
prevention of mother to child transmission of HIV disease among pregnant women
2.
How does the level of education of HIV
positive pregnant women influence utilization of prevention of mother to child
transmission?
3.
Is location of HIV positive pregnant
women a factor influencing the utilization of mother to child transmission?
4.
Does age of HIV positive pregnant women
influence their use of mother to child transmission?
Scope
of the Study
The scope is delimited to pregnant women that attended
ante-natal clinic in Irrua Specialist Teaching Hospital from November 2019 –
March 2020.
Significance
of the Study
It is very important that factors influencing the
utilization of prevention of mother to child transmission of HIV disease among
pregnant women in a resource poor setting should be studied. It is important in
the context of Edo State, where health services are unevenly distributed
between rural and urban areas including distribution of health care providers.
Practicality:-The
findings of this study will be handy for counselling purposes in ensuring
increased utilization of prevention of mother to child transmission of HIV
disease.
Research:
- The
result of this study will increase the existing knowledge on utilization of
prevention of mother to child transmission of HIV disease and will also serve
as research resource materials for further research work.
Nurse/Midwife:
- The
findings of this study will help to improve the attitude of nurses in
delivering Prevention of Mother To Child Transmission of HIV disease to ensure
its utilization by pregnant women thereby decreasing the rate of mother to
child transmission (MTCT).
Government:
-The
findings of this study will help improve policies on findings and distribution
of prevention of mother to child transmission of HIV disease in both rural and
urban area to ensure its utilization.
Limitation
of the study
The
researcher envisages some likely problems in the course of this study such
as: Inability to get the appropriate
information from respondents, Failure, of respondents to return all administered
questionnaire, and Irregular
completion of the questionnaires which may lead to rejection.
Operational
Definition of Terms
Factors:
- are
variables that influence utilization of prevention of mother to child
transmission of HIV disease.
Utilization:
- refers
to the process of using prevention of mother to child transmission services.
PMTCT
Services: Are services that aim at offering preventive
measures toward mother to child transmission.
Ante-natal:
refers
to period from conception to the onset of labor.
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